DALLAS – June 24, 2021 – New Approach Using High-Dose, Precisely Targeted Radiation To Treat Invasive Kidney Cancer Proves To Be Safe, Based On Clinical Trial From UT Southwestern’s Harold C. Simmons Kidney Cancer Program Comprehensive Cancer Center. the study, published in the International Journal of Radiation Oncology * Biology * Physics, could offer new hope to patients suffering from a historically dismal disease.
Raquibul Hannan, MD, Ph.D., associate professor of radiation oncology and immunology notes that SABR stopped tumor growth and, in some cases, induced regression.
Of the top 10 cancers in the United States, most kidney cancers are renal cell carcinoma (CRC). While many cases are caught early, in about 30 percent of patients, RCC has invaded or spread by the time of diagnosis. Kidney cancers have the strange ability to enter draining blood vessels, which become channels for their growth and expansion. After invading the renal vein, kidney cancers travel to the inferior vena cava (IVC), the largest vein in the body. From there they have free passage to the heart. Performing surgery on these tumors is difficult, requiring not only opening the abdomen but often also the chest and placing the patients on bypass circulation.
“It is a difficult surgery which should only be performed by expert teams”, explains the first author. Vitaly Margulis, MD, professor of urology.
Looking for additional options, in 2015, investigators Simmons Cancer Center kidney cancer program, radiation oncology, and urology the departments were the first to new treatment using stereotaxic ablative radiation (SABR). The approach delivered high doses of radiation to extensions of tumor veins.
“SABR has been a success,” says lead author Raquibul Hannan, MD, Ph.D., associate professor of radiation oncology and immunology. “SABR stopped tumor growth and in some cases induced regression. “
Seeking to generalize the application of SABR, the researchers developed a clinical trial. “The first thing to do was to establish that the SABR was safe,” said Robert Timmerman, MD, professor of radiation oncology and neurosurgery, and one pioneer of SABR treatments for many cancers.
The clinical trial assessed the SABR before surgery.
“By irradiating the tumor inside the vein, SABR has the potential to reduce the metastasis of the fragments that break off when the tumor is removed during surgery,” says Hannan, co-head of radiation oncology for the cancer program. kidney.
The first stage of the clinical trial, involving six patients, aimed to establish that SABR did not increase complication rates. Each patient received five doses of tumor-extending SABR in the IVC before surgery. None had serious complications and at a median follow-up of two years, all patients were alive.
“There has been no improvement in outcomes for kidney cancer patients with tumor extensions over the past 50 years,” says Margulis. “This new combination of radiotherapy and surgery could offer new hope to these patients. “
“SABR is likely to have applications beyond the presurgical setting,” explains Hannan. Complementing this initiative, KCP researchers are coordinating an international effort to report on the SABR experience with venous invasion of kidney cancer.
“The development of SABR for intravascular tumor extensions attests to the ingenuity of KCP researchers who venture into uncharted territory for the benefit of our patients and follow these efforts through clinical trials to rigorously assess their potential,” says James Brugarolas, MD, Ph.D., director of the kidney cancer program and professor of internal medicine. “The combined SABR and surgery trial is also a testament to our team approach of leveraging the strengths of all departments. “
Margulis, Hannan, Timmerman and Brugarolas are members of the Simmons Cancer Center, one of about 50 comprehensive cancer centers designated by the National Cancer Institute and the only one in North Texas.
Other UTSW researchers who contributed to this study include Yuval Freifeld, Laurentiu M. Pop, Subrata Manna, Payal Kapur, Ivan Pedrosa, Alana Christie, Osama Mohamad, Samantha Mannala, Nirmish Singla, Michael Wait, Aditya Bagrodia, Solomon L. Woldu and Jeffrey Gahan.
This study was funded by grants from the American Cancer Society (RSG-16-004-01-CCE), the Cancer Prevention and Research Institute of Texas (MIRA RP180725), and the National Institutes of Health (P50CA196516, 5RO1CA154475, U01CA207091 ). The authors recognize the UTSW kidney cancer SPORE pathology core for immunopathology services and basic microarray setup for autoantibody and cytokine multiplex assays.
Brugarolas holds the Sherry Wigley Crow Chair in Cancer Research in honor of Robert Lewis Kirby, MD
Margulis is the Paul C. Peters, MD, Chair in Urology.
Timmerman holds the Effie Marie Cain Emeritus Chair in Cancer Therapy Research.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s leading academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has been awarded six Nobel Prizes and includes 24 members of the National Academy of Sciences, 16 members of the National Academy of Medicine and 13 researchers of the Howard Hughes Medical Institute. The full-time faculty of more than 2,800 is responsible for revolutionary medical advancements and is committed to rapidly translating science-driven research into new clinical treatments. Doctors at UT Southwestern provide care in approximately 80 specialties to more than 117,000 inpatients, more than 360,000 emergency room cases and supervise nearly 3 million outpatient visits per year.